Journal Review in Surgical Oncology: Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 12 June 2023

⏱️ 34 minutes

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Summary

Join the Surgical Oncology team from UTSouthwestern and the University of Miami as they tackle a journal review covering how to choose perioperative antimicrobial prophylaxis for pancreatoduodenectomy. Listen in as they also review novel methodology and the origins of the study.

Learning Objectives:
What antibiotics are you giving before your Whipple? In the group’s final episode together, we review the 1st of its kind, registry linked, pragmatic surgical trial in North America. In the episode we dissect “Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy - A Randomized Clinical Trial” and discuss the practice changing findings, and the future of surgical clinical trials.

Hosts:
Adam Yopp, MD, FACS (@AdamYopp) is an Associate Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.

Caitlin Hester, MD (@CaitlinAHester) is a recent graduate of the MD Anderson Complex General Surgical Oncology fellowship and is now a new faculty member in the Division of Surgical Oncology within the Sylvester Cancer Center at the University of Miami where she specializes in surgery for cancers of the liver, pancreas, and other gastrointestinal sites.

Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-4 Research Fellow and General Surgery Resident at the UT Southwestern Medical Center. He is studying the pancreatic tumor microenvironment and targeted therapies in the lab of Rolf Brekken within the Hamon Center for Therapeutic Oncology Research. He also does work on access to care, social determinants of health, and interventions to mitigate disparities in surgical and oncologic outcomes under the mentorship of Patricio Polanco.

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out surgical oncology episodes here: https://behindtheknife.org/podcast-category/surgical-oncology/

Transcript

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0:00.0	Behind the Night, the surgery podcast, relevant and engaging content designed to help you dominate the day.
0:13.0	Right, welcome everybody to another issue of behind the knife. I'm Adam Yope. I'm the chief of surgical oncology at U.K. Southwestern, and I'm joined by two future leaders in surgical oncology.
0:38.0	Dr. Gilbert Marimwa, who's currently a research resident at U.K. Southwestern, and I'm also joined by Dr. Caitlin Hester, who is an assistant professor of surgery and surgical oncology at the University at Miami.
0:53.0	So, after a two-year run with my colleagues, we're bringing this to an end with surgical oncology. This will be our last podcast, and as we decided to do it, we decided to make this into a so-called journal club.
1:12.0	And we bowed down to the area of pancreatical adjudging that to me in honor of Dr. Hester, her favorite operation.
1:22.0	Sure is.
1:24.0	And we couldn't think of a more fitting way to go out than to talk about the newly published randomized control trial, discussing antibiotic or antimicrobial prophylaxis prior to the Wickel procedure.
1:41.0	And really highlighting some innovative ways that we did the trial with a pragmatic approach.
1:48.0	And some of the kind of discuss, is this really going to change the management to how we give antibiotics for a Wickel procedure?
1:58.0	So, to jump right into it, why don't you really give us a little background and really set the stage for why this trial was needed?
2:06.0	Yeah, I'd love to. So, it will come as no surprise to any of our listeners that although the period operative mortality has dropped to less than 2% for patients undergoing the Wickel, the operation still carries a high morbidity.
2:18.0	The most common source of severe period operative morbidity are surgical site infections and postoperative pancreatic fistula.
2:25.0	So, these complications occur in more than 30% of patients.
2:28.0	And so, making mitigation strategies such as antimicrobial prophylaxis important to figure out how we can continue to move the needle here for the patients.
2:37.0	Yeah, I think that's important.
2:39.0	As we've gotten better as surgeons and taking care of these patients, now we have to look for things that are going to improve the quality of the life and get the patients back to.
2:48.0	Possibly oncologic therapy. So, Kayla, now that you're practicing, now you're out of fellowship, you're building an incredibly robust practice during pancreatic surgery at the University of Miami.
3:02.0	What do you give your patients for preoperative antibiotics, especially for a Wickel procedure? And what are some of the challenges associated with infections and scoop patients?
3:14.0	Well, I think it's important to set the stage and say that this is a highly debated topic amongst HPB surgical oncologists.
3:24.0	It's actually very interesting. The skip actually recommends that we use a first or second generation sephalus borin for prophylaxis for this operation.
3:37.0	Now, even though those are the current recommendations in 2023, I think a lot of surgeons use different antibiotic choices. I know Dr. Yoke has always used Zosin.
3:48.0	When I was in residency with other HPB surgical oncologists, they often use sepharctsatin.
	...

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